GPC England meeting and GP contract update
GPC England met yesterday where the majority of the day was spent discussing the GP contract negotiation proposals, including a package of proposed changes to the current contract.
GPC England voted not to accept the proposed contract agreement with NHS England and NHS Improvement, condemned the draft Primary Care Networks service specifications and called for a Special Conference of English LMCs to allow GP to debate and consider the outcome of contract negotiations once they are concluded.
The feedback about the draft specifications issued by NHSEI has been overwhelmingly negative, with practices, PCN clinical directors, LMCs and local and national bodies all raising concerns about levels of workload involved and recruitment of additional staff, and together giving a clear message that these proposals were not achievable.
We have now returned to negotiations with NHSEI with a clear mandate to secure a deal that truly benefits and safeguards general practice, family doctors and their patients. We are planning an additional GPC England meeting in the next few weeks to consider the position. Read the full statement that we have issued here This was reported by in Pulse, and GP online.
The GPCE executive and policy leads report, which was received by the committee, is attached.
The next GPC UK meeting will take place on Thursday 19 March 2020 in Cardiff, Wales.
PCN surveys
The BMA has published a survey on Primary Care Networks this week, which was completed last year and before the draft PCN service specifications were published. Whilst at the time Clinical Directors believed they could make progress given the necessary resources, time and practical support the survey also found that workload has proven unmanageable for a significant proportion of those responding. GPs wanted more support to help manage this workload and make PCNs work for general practice. The results came on the same day that the deadline for feedback on the draft service specifications ended. The survey findings echo much of the same serious concerns raised by the profession in recent weeks.
A survey carried out by Pulse found that the vast a majority of GP partners (over 80%) will put of the network DES contract if NHS England's proposals for the service specifications remain unchanged. In response to this I said: “These survey findings show the drive and ambition of clinical directors, who want Primary Care Networks to both improve services for patients and begin to address some of the pressures that have been negatively impacting general practice for the last decade. However, it’s clear that PCNs cannot be expected to solve all problems facing the profession and the wider NHS – especially if concerns around present levels of workload are not heeded.” This was also reported by GP online, Telegraph, Mail and GP online. The HSJ (paywall) also reported that NHS England was planning to drop two of the five services it wanted primary care networks to deliver in 2020-21, in response to criticism from GPs.
PCN conference 2020
Following the events of recent weeks the PCN Conference on Saturday 8 February, at the ICC Birmingham, has become an even more important event. It will provide clinical directors and LMC colleagues with an opportunity to make your views heard about the challenges you are facing. Whether it is the difficulty in recruitment, workload challenges, or the draft specifications released by NHSEI, this will be an opportunity to speak to national bodies and shape the direction of travel. At this crucial time for the future of PCNs and following the concerns many have about the draft DES specifications, this is an opportunity to discuss ways forward. You can read more here
The GPDF has funded one seat for each LMC, which can be booked here; for any additional LMC seats please go through the standard booking form above.
BMA secures significant High Court victory over unlawful pensions changes
The BMA has today secured victory in the High Court over controversial changes made by the Secretary of State for Health and Social Care to the NHS Pensions scheme in England and Wales.
In April 2019, the Government amended the NHS pension rules in order to grant the Secretary of State the power to suspend payment of pensions benefits to any doctor or NHS professional who had been charged with certain criminal offences but not yet convicted. These changes, which also did not include a right to appeal or a provision for the suspension of payments to be lifted automatically upon acquittal, were a total disregard of the principle that a person charged with a crime is presumed innocent until proven guilty.
Despite concerns raised by the BMA before their implementation, the Government proceeded with their reforms leaving with the BMA with little choice but to take legal action to seek to force their reversal through a judicial review.
Most, if not all, public sector pension schemes contain provisions for the suspension of a person’s benefits but only after the point of conviction. Yet, if the changes were to be allowed to subsist, NHS professionals would be the only public sector workers to have the threat of forfeiture of their pension hanging over them at any time from charge.
However, in a judgment handed down today, the High Court agreed with our argument that the new regulations breached Article 6 (right to a fair trial), Article 14 (protection from discrimination) and Article 1, Protocol 1 (right to peaceful enjoyment of property) of the European Convention on Human Rights (ECHR) and also breached the Public Sector Equality Duty (PSED) under the Equality Act (in failing to have regard to the equality implications of the changes).
This is a significant BMA victory not only for our members but for all doctors and their dependants and other NHS professionals in the NHS Pension Scheme in England and Wales.
In the judgment handed down the Hon. Mrs Justice Andrews described how the Government had drawn no distinction between someone charged with a crime and someone convicted of a crime despite the fundamental principle in law being that “every defendant to a criminal charge, however serious, and however compelling the evidence against him may appear, is presumed innocent until proved guilty to the criminal standard.”
This is of course not the only pensions related work the BMA is undertaking. Our campaign continues to convince the Government that removing the annual allowance, including the taper in defined benefit pensions schemes, is the only long-term solution to crisis caused by punitive pension taxation charges.
Yesterday we were clear that the latest proposal to raise the annual allowance threshold income to £150,000 would not “fix the fundamental problem of doctors being forced to limit the work they do to prevent being hit with significant charges on their pensions and many will still in effect be paying to go to work.” Read more about this issue and our response to The Times article here.
Flu TIA coding error
NHS Digital has emailed practices about an error with the Seasonal Flu 2019/20 extraction where the codes for patients in under 65 at-risk groups with TIA were inadvertently removed from the business rules. This means that these patients are not being included in the payment extraction despite vaccines having been given and coded appropriately. It is anticipated that the number of missed payments will be low, as it is likely that most people will have other risk factors that are captured by the current business rules. There will be a single collection in April 2020 for payment in 2020/21.
Practices will need to accept the service offer (as for any other service), when it is made available on CQRS. Practices are also encouraged to double check that all patients under 65 with TIA have been offered the flu vaccine this season. Read more in the attached document.
Premises claims against NHSPS
The BMA has proceeded to lodge claims with the High Court on behalf of five test claimant practices that are challenging the basis of their inflated service and facilities management charge demands from NHS Property Services. The action seeks to obtain a declaration that NHSPS’s ‘Consolidated Charging Policy’, which it has relied upon as the basis for its demands, does not form part of the tenancy agreements between the claimant practices and NHSPS, and as a result cannot be relied upon as a lawful basis for the inflated charges being demanded.
LMCs and practices are advised to continue to refer to the attached guidance issued by GPC in December 2019 regarding the action and advice relating to pressure to sign new lease agreements or other forms of agreement such as ‘rental agreement letters’.
GP pressures
GPs and practice teams are delivering an increasing number of appointments (28.5 million in November 2019) and providing care to a more complex patient population. This burden is being provided, with insufficient resource provision to match demand. In particular, the decreasing number of trained GPs (28,213 FTE in September 2019, a 1.2% decrease from September 2018) is impacting not only on GPs and other members of the practice team but also particularly patients who are having to wait longer than necessary for GP appointments. Whilst it is not possible with current data recording to know what proportion of patients are choosing to book ahead for planned appointments, in total 19.1% of appointments in November 2019 were preceded by a wait longer than two weeks.
The latest BMA analysis of GP data uncovers the trends behind these numbers, evaluating how general practice is faring in the face of increasing pressures across the health system.
Health and Social Care Network (HSCN) – Your future GP connectivity
NHS Digital has drafted the attached briefing about the Health and Social Care Network (HSCN), which is the replacement connectivity solution for healthcare to deliver modern digital care services. This will replace the old N3 network - also called the transition Network (TN). HSCN will provide several advantages to practices, such as faster connectivity at reduced prices, supporting initiatives such as Digital First; improved performance for primary care systems, including e-prescribing and simplified connectivity with third sector providers, for referrals and discharge notifications.
MMR campaign materials
Next week, NHSE/I will be sending posters and counter cards to all practices in England to support the NHS ‘Measles, Mumps and Rubella (MMR) – Help Us Help You, Get Protected’ campaign. These materials have been developed to support practices in encouraging their patients to get protected against measles, mumps and rubella, by getting the MMR vaccination. Posters and reception counter cards will be posted to GP practices for w/c 20 January 2020. A digital pack including these and further downloadable materials including social media content and digital screens will also be available on the Campaign Resource Centre
Corona Virus infection outbreak
A corona virus infection outbreak declared by the Chinese authorities, and Public Health England have distributed the attached document through their systems. With the upcoming Chinese New Year on 25 January, practices should be vigilant if patients present with recent history of travel to China/ close exposure to birds/ respiratory symptoms. GP action is limited to:
1. Call the ambulance service explaining your suspicions. The ambulance service has the responsibility to deal with the transfer and the destination hospital
2. Keep the patient in one room and turn off the air conditioning
Overseas doctors are vital to plug workforce shortages
The Sunday Mirror [paper version only] ran an article which warned that doctors from overseas trying to work in Britain are facing “too many bureaucratic barriers” despite severe shortages in general practice. In response to this I said: “The current recruitment crisis means we are heavily reliant on GPs coming here from overseas. The immigration and medical regulatory system still has far too many bureaucratic barriers. Streamlining the system must be a priority for politicians if we are to see a tangible improvement in numbers.”
Frail patients medicine reviews
The Guardian reported on an analysis of NHS Digital data carried out by the Pharmaceutical Journal, which showed that almost 75,000 severely frail, older people in England are missing out on vital medicine checks, putting them at risk of hospitalisation, falls and adverse drug reactions. In response to this I said these figures may say more about coding and recording, and “A clinician will review the medication when they see patients or a prescription is done, but may not necessarily code this”. Read the full article in the Guardian
GPC UK Regional elections
Nominations for GPC UK regional representative are now open, for more information see here.
Nominees should be aware that the BMA is currently in the early stages of reviewing its governance structures, which may have some potential to impact on the length of terms of office and regional remits during a term of office. The nominations close at 12pm Monday 3 February. For further information and to nominate yourself for a seat click here. If you have any queries, please contactelections@bma.org.uk
See the last GPC bulletin here
PCN DES draft Service Specifications – summary for GPC and LMCs
The response to the NHS England and NHS Improvement draft PCN service specifications has been significant, with unprecedented numbers responding to this important survey. We are pleased that so many LMCs and PCNs have already submitted their responses to the service specification consultation. There is still time to send further feedback, including from the many LMCs and PCNs that have meetings in the next week. We have produced the attached summary in table form which summarises what would be required, who from PCN workforce could deliver it, what the role of the community teams might be, and what the outcome measures are.
In response to these concerns I said: “General practice continues to be under a huge amount of pressure and we hear the concerns raised by the profession in recent weeks about these draft specifications, the workload implications and the need for a qualified workforce to deliver them, loud and clear. While the content of negotiations is confidential, the profession should rest assured that we are listening to doctors on the ground, reviewing their feedback and this will form the basis of talks with NHS England to ensure that the specifications are fair and appropriate before they are agreed.” The BMA has reported it on this and commented on twitter, and it was also covered in Pulse, GP Online, and GP online.
The HSJ (login required) have also commented today that “NHS England looks likely to row back quickly on its proposed requirements on GPs and primary care networks, after a deluge of strong opposition from GPs and others. Responding to criticism of the specifications which GPs would be asked to deliver as part of their PCN, NHSE director of primary care Nikita Kanani said: “The feedback is crucial and will absolutely be heard and reflected.”
Meeting with Health Minister
On Wednesday I met with Jo Churchill MP, the health minister with responsibility for primary care in England. We joined with Prof Martin Marshall, chair of RCGP, Nikki Kanani, Medical Director of Primary Care, NHSEI, Dr Rosie Benneyworth, CQC’s Chief Inspector of Primary Medical Services and a group of GPs from around the country. It was a long and helpful meeting, providing a good opportunity to discuss with the health minister the key issues facing general practice and she was left in no doubt about the challenges we face and the support we needed from the new government.
GP appointments wait
The Sunday Times (login required) reported that around 11 million patients waited more than three weeks for a GP appointment in England in the most recent four months for which statistics are available. The article referenced Boris Johnson's pledge, soon after becoming Prime Minister, in which he said that his "job is to make sure you don’t have to wait three weeks to see your GP". In response to this I said that these figures “come amid a backdrop of falling GP numbers because, despite their best efforts, many practices simply do not have the capacity to meet the ever-increasing demand” and that Boris Johnson’s promise to increase appointment numbers by recruiting more GPs “will require sustained investment and ensuring that it is easy to recruit overseas doctors”. The story was also reported by i News, MailOnline and Pulse (log-in required).
NHS IT investment
The Department of Health and Social Care and NHSX have announced that they would be investing £40 million in updating NHS IT, beginning by focusing on speeding up login times by minimising multiple logins. In response to this, Chaand Nagpaul, BMA Council chair said that reducing multiple logins was a positive step, but that this would “not in itself address the overdue and urgent need to upgrade antiquated hardware and software in the NHS, and that we needed “to see an absolute commitment to interoperability so that different systems communicate with one another effectively, and we need to see a clear action plan of how this will be achieved”. This was reported by the BBC, the BMJ and the Times print edition.
GP earning figures
The Sun reported on figures which they said showed that over 160 GPs were paid more than £200,000 in 2017/18. In response to this I said that high earners are “more likely to be managing a business operation who are set up to manage multiple practices, rather than being on the front line of general practice seeing patients”. This was also reported by the Mail and Pulse.
Gender pay gap
The Institute for of Public Policy Research has published report which showed that women GPs earn an average of £40,000 a year less than their male colleagues. The IPPR argue that this is because of the existing GP partnership model and women being underrepresented amongst GP partners.
In response to this, Farah Jameel, GPC England executive team member said: “The gender pay gap in this day and age is something that we as a society should be ashamed of, and we need to work harder to examine more closely and address the issues that lead to this in the medical profession. For many female doctors – many of whom will have family or caring responsibilities – working flexibly is the right thing for them, and salaried roles at present are able to provide a greater control over work-life balance. However, partnerships too can offer a great opportunity for flexible ways of working, which could be positive for the recruitment and retention of women, but action must first be taken to reduce the risks that put off GPs of all genders from currently taking on this role.”This was reported by the Independent
PCN conference 2020
At this crucial time for the future of PCNs, there is an important opportunity to join other PCN leaders and share best practice and build supportive relationships at the PCN Conference on Saturday 8 February, at the ICC Birmingham. It should be an interesting day and give people a flavour of how different PCNs, CCGs, LMCs across the country are doing things and giving PCNs ideas for the future and maybe how to do things differently for greater benefit. If you haven’t already signed up then you can do so here.
The GPDF has funded one seat for each LMC, which can be booked here; for any additional LMC seats please go through the standard booking form above.
CCG mergers guidance (England)
The BMA has produced new guidance on CCG mergers in England, to help GPs and LMCs get to grips with the changes taking place. This includes information on why, how, and when mergers are likely to take place, as well as advice on how to approach them, and examples of ways in which LMCs and grassroots GPs have influenced and shaped mergers in their areas. Read more here.
Online consultations toolkit
NHS England has published a toolkit to inform staff in practices and commissioning organisations who are implementing online consultation systems. There is a shortened version aimed at GPs and other practice staff, as well as a full version of the toolkit for those who are leading these projects.
BMA mental health workforce report
The BMA published a mental health workforce report yesterday, which revealed that over half of respondents said they were too busy to provide the care they would like to be able to give, with 44% saying that they felt demoralised and the same number saying their workload was unmanageable. It also showed that around two in five GP appointments now involve mental health, while two in three GPs say the proportion of patients needing help with their mental health has increased in the last 12 months. Read more here. This was reported by GP Online, and OnMedica.
RCGP (Royal College of GPs) Workforce Roadmap
The RCGP has launched a workforce roadmap, calling on the Government to take urgent action on the GP workforce with clear targets for expanding the entire general practice workforce, a commitment to increase GP training places to 4,000 in 2020/21 and to 5,000 soon after, and significant investment into initiatives to improve GP workload and retain existing GPs in the profession. This was reported by the BBC and I responded publicly in support of the RCGP’s recommendations.
Supply Disruption Alert for Phenytoin 100mg capsules
The Department of Health and Social Care has informed us that a supply disruption alert for phenytoin 100mg capsules has now been issued and can be found here.
GPC Regional elections
The nominations for the following GPC UK regional seats will open on Monday 13 January at 12pm:
Child Safeguarding Judicial Review
Following longstanding concerns about the failure of many areas to make proper payment to cover the costs to practices for work covered by collaborative arrangements, as I said at the LMC England Conference, the BMA launched an application for judicial review in Northamptonshire challenging the failure to make any financial provision for child safeguarding services provided by GPs. We have now been informed that our application for judicial review has been granted permission by the Administrative Court, which will be listed in the next few months. The focus now will be on collating mutual Counsel availability times to try to lock in a date which the parties can all do.
PCN Service Specifications survey
As I highlighted earlier this week, NHS England and NHS Improvement have published draft PCN service specifications and an accompanying survey asking for feedback. GPC England will engage with NHSEI in negotiations on the service specifications in the coming weeks and this will be influenced by the responses to the consultation. GPC England will be meeting on 16 January to discuss these proposals from NHSEI. We would therefore ask LMCs to circulate the link to the survey to local practices and clinical directors and to encourage as many as possible to make their views known as soon as they can.
NHSEI are also running a series of webinars where the outline service specifications will be discussed, on Wednesday 8 January 2020 at 12.00-1.30pm and Thursday 9 January 2020 at 10am-11.30am. Nikki Kanani, NHSE Medical Director for Primary Care, will also be hosting a #primarycarenetworks Twitter chat on 7 January 2020 at 20.00. In addition a webinar focusing on the community services elements of the Enhanced Health in Care Homes and Anticipatory Care service specifications, aimed at directors and chief executives of community health providers will be held on Tuesday 14 January 2020 – 3pm-4.30pm.
For community health providers, NHSEI plan to commission service requirements via the NHS Standard Contract. These requirements form part of the consultation on the Standard Contract, which will run from 19 December 2019 to 31 January 2020 and can be found here.
Primary Care Network conference
It is still possible to book to join a large number of PCN leaders at our second PCN Conference which will be on Saturday 8 February, at the ICC Birmingham. This will be an important opportunity to learn about what is happening in networks around England, share good examples and explore solutions to problems. Please see attached the outline programme which is also available on our PCN Support webpages https://pcn.bma.org.uk/
For more information and to get your early bird discount by 8 January see this page www.bma.org.uk/pcn-whats-next
PCN Service Specifications survey
NHS England and NHS Improvement have published draft PCN service specifications and an accompanying survey asking for feedback. GPC England will engage with NHSEI in negotiations on the service specifications in the coming weeks and this will be influenced by the responses to the consultation. We would therefore ask LMCs to circulate the link to the survey to local practices and clinical directors and to encourage them to make their views known as soon as possible through a response.
NHSEI are also running a series of webinars where the outline service specifications will be discussed, on Wednesday 8 January 2020 – 12.00-1.30pm and Thursday 9 January 2020 - 10am-11.30am. In addition a webinar focusing on the community services elements of the Enhanced Health in Care Homes and Anticipatory Care service specifications, aimed at directors and chief executives of community health providers will be held on Tuesday 14 January 2020 – 3pm-4.30pm.
For community health providers, NHSEI plan to commission service requirements via the NHS Standard Contract. These requirements form part of the consultation on the Standard Contract, which will run from 19 December 2019 to 31 January 2020 and can be found here.
GP shortages
Following the new Government's pledge to invest more into the NHS, the Times published a series of articles highlighting the workforce crisis in general practices. In response to this a letter I wrote to the Times was published, where I said: "Your important investigation (“One doctor for 11,000 patients in GP shortage”, Dec 21) underlines the crisis in general practice that my colleagues and I at the BMA have been vocal about for years. We do not have enough GPs to meet the needs of our growing population: many people are living with increasingly complex conditions. This inevitably means that some patients are waiting too long for an appointment, which is distressing for people who are ill and frustrating to practice staff, who want to provide the best care possible”.
I also spoke on LBC radio last week to discuss OECD research which found that Britain has the second lowest number of doctors per capita in Europe, after Poland, where I said: "The number of doctors has not kept pace with the rising population or the complexity of our patients. It's been a really good thing that more people are living longer into their 80s and 90s, but that also means that they are more in need of healthcare, and so we need to grow our medical services - not just doctors, but nurses and others as well, to be able to support the growing needs of our patients. If we don't do that then we put added burden on clinicians and that's when they themselves become burned out and leave."
NHS investment
The Sunday Times (sign-up required) also reported on the letter from Chaand Nagpaul, BMA council chair, to the Prime Minister warning that the Government's NHS election pledges will not be enough to rescue it from crisis, and that there will still be a funding black hole of £6.2 billion a year by 2023-24. The story was also covered by Eastern Eye, Yahoo News, NDTV, Business Standard, Devdiscourse, Outlook India, and Medical Dialogues.
PHE to cut New Year anti-smoking campaign
I was interviewed by BBC 4 Radio’s World at One programme on Friday about the news that Public Health England will be cutting back on its New Year anti-smoking campaign due to a fall in Government funding. I highlighted the concern about these proposals and said: "We are seeing patients in our surgeries on a daily basis who still smoke; we try to provide advice and guidance to them but we need the help of Government, and we need the help of public health budgets." Listen to the full interview on BBC Radio 4’s World at One here (from 22mins in).
Influenza 2020/21 letter
NHS England and NHS Improvement has now published a letter based on the recommendations by Joint Committee on Vaccination and Immunisation (JCVI) which sets out the vaccines that should be offered to eligible people and the reimbursement guidance for 2020/21.
New Year’s honours
I would like to congratulate a number of GPs who we regularly work with who received honours in the Queen’s New Year’s honour list:
Dr Jonathan Leach, joint honorary secretary of the Royal College of General Practitioners, was awarded an OBE for services to general practice. Read more here.
Dr Victoria Tzortziou-Brown, joint honorary secretary of the RCGP, was also awarded an OBE for services to general practice. Read more here
Dr Henrietta Hughes, National Guardian for the NHS and General Practitioner, was awarded an OBE for services to the NHS.
Professor John Campbell, Professor in General Practice and Primary Care at Exeter University, was awarded an OBE for services to general practice.
Introductory meeting with England Chief Medical Officer Prof Christopher Whitty
Just before Christmas, I joined Chaand Nagpaul, BMA chair of council, in a meeting with the recently appointed England CMO Professor Christopher Whitty, who is also Chief Scientific Advisor for the Department of Health and Social Care. He is a practicing consultant physician in infectious diseases.
It was a good opportunity to discuss with Professor Whitty his thinking about the NHS and the medical profession. He was particularly interested in the role of general practice within the NHS, and it was useful for me to be able to brief him on the realities facing GPs and how they can be better supported.
Medicine supply update
Please see attached the medicine supply update from the Department of Health and Social Care for December. There are also tier 2 shortages of clonidine 25mcg tablets and h2-antagonists (cimetidine, famotidine and nizatidine), and a supply disruption alert for ranitidine (all formulations) is available at SDA/2019/005-U2. A tier 3 supply disruption alert for Convulex capsules (valproic acid) was issued on 23 December and is available here.
Serious Shortage Protocol for haloperidol
The DHSC has issued a Serious Shortage Protocol (SSP) for haloperidol (Serenace®) 500 microgram capsules which took effect on 23 December 2019 with an expiry date of 23 March 2020. Where prescriptions are presented for the haloperidol 500microgram capsules, this SSP allows pharmacists to supply haloperidol 500microgram tablets. For more information see the SPS website.
RPS: New competency framework for designated prescribing practitioners
The Royal Pharmaceutical Society (RPS) has published a Competency Framework for Designated Prescribing Practitioners for use by all the non-medical prescribing professions. The Framework supports individuals across all independent prescribing professions, training providers and universities to understand what competencies must be met to provide safe and effective prescribing supervision to independent prescribers.
Read the latest GPC newsletter here.
General election: Government pledges on NHS investment
I spoke to LBC on Sunday (just after 5pm) about the new Government's pledge to invest more into the NHS, where I said that the money promised is not enough, and that the Government must recognise that we have a growing, ageing population, which needs a stable health service to keep up with demand. I also mentioned the pensions issue and explained why this is deterring doctors from doing extra shifts in the NHS, or wanting to stay altogether. I also spoke to BBC York on Monday morning (interview starts about 2 hours in).
Dr Helena McKeown, chair of the BMA representative body, also spoke to BBC Wiltshire (7am) and BBC Humberside (9.15) on Monday, and said that now is the time for the Government to make a real difference on the frontline of the health service - something which was reiterated in our letter to Boris Johnson last Friday. She said the Conservative manifesto is 'promising, but not enough', and that she has concerns about attracting more healthcare professionals to the NHS.
BMA council chair Chaand Nagpaul has written to the prime minister calling for decisive action from the new Government to tackle NHS pressures and deliver real change for staff, patients and services. Read the letter
BMA Legal action against NHS Property Services – Service and Facilities Management Charges
As you know, over the last three years many practices have seen significant increases in service charges and facilities management costs without prior agreement while some report being billed for services they are not receiving. This situation is placing unsustainable pressure on practices and is essentially diverting precious resources away from patient care. Furthermore, we know that this it is destabilising the future of practices as many young doctors are discouraged from becoming GP partners where this issue remains unresolved. The overall impact of this ongoing dispute is having a devastating effect on the profession.
The BMA has repeatedly pressed NHSPS to cease its inflated demands and to provide a proper explanation for the charges. Unfortunately, discussions and negotiations have reached a standstill. Consequently, the BMA wrote to NHSPS earlier this year, setting out why it believes NHSPS is acting unlawfully but received no acceptable response. Therefore, as you know I announced at the Annual Representative Meeting in Belfast in June this year that the BMA is now taking NHSPS to court.
I attach a letter to you from Gaurav Gupta, GPC premises and practice finance lead, updating you further on progress.
CCG mergers guidance
Following the recent debate at LMC England Conference we are developing a “Focus on CCG mergers” guidance document outlining our work on CCG mergers which we will publish shortly. As outlined both by LMCs and in our letters to NHS England, mergers present a number of issues for practices, including the potential loss of local influence, continuity of funding and support, and understanding of the local population’s needs. We have also received a number of examples of mergers being carried out with poor quality and limited engagement with member practices.
We have raised each of these issues with NHS England and their most response sets out their position on each. The response also includes a request for any examples of issues with mergers locally, which we may wish to highlight. Therefore please share with us any further examples and in doing tell us whether there been consultation with the LMC or BMA regional council and if so, is there support for the merger plans, whether you are aware of any support from local public (Healthwatch, patient groups, etc), and whether the relevant information including financial and service implication been provided with enough time to properly consider documentation ahead of votes? Please send any examples or feedback to tbramwell@bma.org.uk
Performers List Online Service
The new online Performers List service has now been launched by NHS England and is being managed by Capita (PCSE). Over the next few weeks GPs will be automatically registered on PCSE Online. You may have recently received an email from PCSE, with a link for you to verify your account. This is a legitimate email and we are recommending that you follow the link and verify your account – you will need to do this within 72 hours of receiving the link. If the link has expired you can use the ‘forgotten your login details’ button on the PCSE Online homepage.
If you have not received this email you will need to check that you have an email address registered with the GMC and/or that this is up to date. You can do this by logging into your GMC Online account and updating the ‘My details’ section, by emailing gmc@gmc-uk.org or by calling the GMC on 0161 923 6602.
The new online Performers List essentially is a move from a paper application to an online application and we have been involved in the development of the system.
There has been some concern regarding a tick box which asks for your permission for your details to be shared with your Local representative committee; this is your LMC. Please do share your details as this will allow your LMC to contact you. Capita (PCSE) cannot share your details with anyone else.
We would strongly recommend signing up to the new Performer’s list.
Practice e-declaration
Following concerns raised by practices completing the e-declaration about including an email address, we raised this issue with NHSEI. They have now modified the declaration so that practices can leave the data field relating to the email address blank. However, this only applies to those practices who have not yet submitted their form, it cannot be changed retrospectively. Email addresses already submitted will not be published on NHS Choices.
Influenza Season 2019-2020
A delay in the delivery of some influenza vaccines this year meant that the flu vaccination programme started later than usual; further supply constraints then occurred with the children’s nasal vaccine. Although these issues are now resolved, vaccine uptake rates are around 5% lower than expected for this time of year for those in clinical risk groups under 65 years. Of particular concern is uptake for two and three year old children, which is around 8% lower than the same time point last year. The data suggests that practices are working hard to catch-up and we would like to thank all the GPs, practice nurses and other practice staff who support the programme. Unfortunately, however, we have already started to see early influenza activity in the community, particularly in the northern part of England. School children have been particularly affected and several paediatric deaths have already been reported, as well ICU admissions. The predominant strain causing cases this year appears to be well matched to this season’s influenza vaccine, and so we hope that practices will be able to continue these efforts to ensure as many children and younger adults are protected as possible.
Updated BMA handbook for salaried GPs
The sessional GP committee has just updated our salaried GP handbook which is written for salaried GPs and GP employers. It will also be of interest to those who are intending or about to become salaried GPs. It explains the legal entitlements of salaried GPs as employees and helps to ensure that salaried GPs are aware of their statutory and contractual rights. It also helps to prevent GP employers contravening the law unwittingly. In addition, it explains the national and local representation of salaried GPs, how to become a salaried GP and the work involved.
One of the aims of this handbook is to help ensure that all salaried GP members receive appropriate employment terms and conditions. It does this by setting out the legal entitlements that salaried GPs receive as employees, as well as the additional contractual benefits that are, or may be, available. It provides a comprehensive overview of the employment contracts available to salaried GPs and the effect of the various provisions of the model salaried GP contract. The handbook also provides guidance on negotiating improvements to salary and other
contractual provisions.
The handbook provides detailed guidance for salaried GPs. However, this cannot replace the expert and confidential advice on individual employment issues that salaried GPs should and can obtain. This is available as part of BMA membership by contacting the BMA.
Also, a specialised and invaluable benefit of BMA membership is the employment contract checking service that is offered. The BMA will review the employment offer letter and terms and conditions, and advise on any necessary improvements.
The handbook is a valuable tool for GP employers. It explains the statutory entitlements that a GP employer must provide to its salaried GPs in order not to fall foul of the law. It also highlights various contractual obligations, including those under the model salaried GP contract.
You can access the updated handbook here.
Pensions
A special edition of the PCSE GP Bulletin had been published, which covers the End of Year Pension administration processes for 2020 and an update about Annual Benefit Statements (ABS). NHS Pensions has released the Type 1 Annual Certificate of Pensionable Profits and the Type 2 medical practitioner self-assessment form will be available very soon. In this bulletin we will help you understand what you need to do in order to prepare End of Year Pension administration in 2020.
NHS Pensions has confirmed that the following pension forms and associated guidance notes have now been published and are available to download from the NHS Pensions website here.
The following pension forms and associated guidance notes have now been published:
Type 2 medical practitioner self-assessment forms 2015/16, 2016/17, 2017/18 and 2018/2019
To read the full bulletin click here
GMC’s State of Medical Education and Practice annual report
The GMC has published its State of Medical Education and Practice annual report. It notes that 45% of GPs reported working less than full time (61% female GPs compared with 26% male GPs), 36% have reduced their hours in the past year, and many are considering leaving the profession altogether (18% in the next year). Increasing workloads has resulted in two thirds of GPs working over their rostered daily hours with 19% taking stress related absence over the last year. 92% of GPs reported that they felt unable to provide sufficient levels of care at times while a quarter reported witnessing patient care being compromised. Despite this, the report also notes that around half of GPs are satisfied in their work, largely driven by a sense of fulfilment.
PCN conference
Join other PCN leaders and gain insight into what’s happening across England, share best practice and build supportive relationships at the PCN Conference on Saturday 8 February, at the ICC Birmingham. Learn more and get your early bird discount at www.bma.org.uk/pcn-whats-next
Social Prescribing webinar
The National Association of Link Workers is running a short webinar on 30 January for anyone interested in getting a bit more information about Social Prescriber Link Workers and their involvement in PCNs. LMCs and PCNs can register here.
Read the latest GPC newsletter here.
Read the latest Sessional GPs newsletter here.
BMA letter to the Prime Minister
Following the general election, BMA council chair, Chaand Nagpaul, has written to the Prime Minister calling for decisive action from the new Government to tackle the NHS pressures and deliver real change for staff, patients and services. Read the letter to Boris Johnson and BMA comments here.
Annual allowance tax charge
The BMA has now fully considered the proposals from NHS England and Improvement to provide emergency mitigation for clinicians that incur annual allowance tax charges in 2019/20. We welcome their short-term plans to tackle the NHS pensions crisis, but have made it clear that further assurances must be made for GPs.
It is essential that doctors working in primary care are covered by these proposals. NHSEI has committed to ensure that is the case and the BMA will work with it to ensure a solution is found to provide similar guarantees for GPs. Read the BMA statement and the NHSEI FAQs here.
The story was covered in GP Online, Medscape, and Practice Business
Final pay control regulations for pensions (UK)
The final pay control regulations were introduced from 1 April 2014 to protect the pension scheme from the costs that arise where an employer awards an exceptionally high pay rise to a member of the 1995 section of the NHS Pension Scheme, to achieve an inflated pension benefit. Under the 1995 Section of the NHS Pension Scheme, a scheme member’s pension is calculated using their highest salary in their final three years of pensionable service. As a consequence, a member who has a significant pay increase in their final three years will receive a substantially larger pension than they would have received without the pay increase. Practice partnerships, as employers, can receive final pay control charges if they award a pay increase that exceeds the allowable amount.
Since the introduction of the regulations, a number of exemptions have been introduced to stop employers receiving a final pay control charge for awarding significant pay increases for genuine reasons. These recent exemptions include:
The BMA has been working with other trade unions, NHS Employers and Department of Health and Social Care to ease these regulations and allow for a far less strict interpretation of the regulations. As a result we hope to see developments in the near future that will increase the allowable amount, add further exemptions to the final pay control regulations, allow more discretion in the regulations and restricting the payment of charges to being pursued above a certain minimum level. Practices should discuss those issue with their accountants. Please note that this does not relate to GP partners but to final salary scheme doctors.
GP shortages
An analysis by the TUC has shown that the number of GPs has fallen by nearly 1,000 since 2015 despite rise in demand. In response to this I said: ”There are simply not enough GPs to meet demand and guarantee safe, quality care. Despite pledges to increase numbers, we’ve seen the exact opposite.” Read my full statement here. It was reported by the Mirror and ITV. GPC member Ian Hume was interviewed by BBC Radio Cambridgeshire about the promises made by political parties in the run up the election, and said: “Funding is important but it’s not all about funding. It’s about listening to the profession and making sure we have a plan which is credible and which people will believe in.” Listen to the full interview here (from 2h22min).
PCSE online update
The new PCSE online service for submitting Performer List (PL) applications and changes is now live and replaces the old paper forms. Every doctor on the PL will receive an email requesting that they set up their own PCSE online account and we expect all GPs to have received their invitation by Christmas 2019. This will enable GPs to check their details are correct and provide access to the new online system to make changes.
The email will be sent to the same email address used for professional communications with the GMC - any amendments to this email needs to be made via GMC online. However, the vast majority of GPs should receive an invitation from PCSE.
All GP practices will be sent a letter to their CQC manager, detailing how to register the practice for PCSE online. Only 20% of practices have so far registered; it is vital for the majority to register, as otherwise the system will not work efficiently. Historically we have seen significant problems arising by such delays, particularly affecting appropriate pension deductions and prescribing numbers, so it is worth checking that your practice has registered.
It is prudent to remind individual GPs that regulations require that a performer informs NHS England of change of status and details. Changes to contractual status also requires notification by the GP and confirmation from the practice and finally contract changes by NHS England, so both practices and individual doctors should sign up to PCSE online.
The new system will allow all GPs to check their details are correct, so it is worthwhile to log in to check the details, given the inaccuracies in the present list. There will inevitably be teething problems, but GPC is in regular contact with PCSE, so please do highlight any issues so we are aware and can work with PCSE to resolve problems by emailing info.gpc@bma.org.uk
Updated Additional Roles Reimbursement Scheme guidance
We have been encouraging practices to transfer Clinical Pharmacists from previous schemes to the new PCN ARRS scheme, as this will be to the benefit both of those practices and their PCN in the long term. As there are still some practices yet to take the
necessary action, we have requested that the deadline to make this change be changed and we are pleased therefore to have agreed with NHS England that this will be extended to 31 March 2020. In order to reduce future risk (of including these Clinical Pharmacists
in the baseline) for all members of PCNs, we advise that practices seriously consider transferring any CPs on the previous national schemes.
This extension to the deadline, and the information about funding for covering management fees for subcontracts for Social Prescriber Link Workers have been included in the latest update to the
ARRS guidance and can be found at para 2.3.6 page 9 and 2.3.1 page 5 respectively.
NHS 111 Data Sharing Agreements
We have had queries from practices regarding NHS 111 asking practices to sign Data Sharing Agreements in order to gain full access to patient health records via GP connect. As you are aware under the 2019/20 GP contract, practices are obliged to make available one
appointment per 3,000 patients per day for NHS 111 to book directly into practice appointments. This is provided that the functionality and governance exist. We have been informed that some practices have been sent DSAs by NHS 111 providers to enable direct
booking. Our understanding is that a DSA is not necessary for the purposes of assigning an appointment only as it does not require access to the patient’s medical record and NHS 111 appointment booking contract agreement is not an agreement for NHS 111 to
access medical records.
Furthermore, DSA is not required when one independent data controller (i.e. NHS 111) is sharing personal data with another independent data controller (i.e. the GP practice). This also reflects usual practice in the health service when data are continuously shared between primary and secondary care for direct care purposes, such as referrals, without the requirement for a DSA. We have raised our concerns on a national level and once we have further clarity will share this with practices.
Primary care-based opioid and pain review service
A small study published in the British Journal of General Practice has shown that one-to-one pain service in general practice was successful in reducing opioid use in 40% of patients, cutting GP consultations and improving health and wellbeing. In response to this, Krishna Kasaraneni, GPC England Executive team member said: 'It’s important that patients affected by prescribed drug dependence have access to the care and support they need, and the BMA has been working with stakeholders for some time now to identify ways to do this. As part of this, we welcomed Public Health England’s review earlier this year, which recommended the need for a national helpline and commissioned support, as well as evaluations of existing services of the type examined in this study.'
This was reported in Pulse (sign-in required)
GP pressures
General practice is facing a larger than ever burden of appointments from an increasingly complex patient population, with resources and workforce levels not keeping pace with demand. This is impacting on GPs, other members of the practice team and on patients
and has been one of the central debates in the general election campaign.
BMA analysis of the latest data highlights how appointment and patient numbers, GP appointment wait times and workforce numbers are faring in the face of increasing pressures across the health system.
Legal action against NHS Property Services
Find attached a letter from Gaurav Gupta, GPC Premises policy lead, with an update regarding the BMA’s legal action against NHS Property Services – please share this with your practices.
Welsh LMC conference resolutions
The resolutions from the Welsh LMC conference have now been published and are available here
BMA presidential essay competition
As part of the President’s project this year, the BMA has launched an
essay competition on the theme of ‘justice and fairness in medical practice and policy’, with a £4000 prize. The competition is open to all UK residents who are not representatives or staff members of BMA or BMJ. Entrants are asked to submit a 100 word
abstract, and those shortlisted will be invited to write a 5000 essay. The deadline for submitting abstracts is 30 January 2020. Read more in a
blog by the BMA president, Professor Raanan Gillon.
Disability survey
What is it like to train and work as a GP when you have a disability or long term physical or mental health condition? What are the key challenges you face, and how could you be better supported? Disabled doctors and medical students are a valuable part of
a diverse medical workforce. The BMA is committed to improving the support that it provides to doctors at all stages of their careers. We particularly want to hear from GPs on this important issue to help us better represent you. Please fill in this short,
anonymous
survey and tell us your views.
Committee visitors scheme for GPC meetings
The BMA committee visitors scheme allows interested parties to participate as non-voting committee member of GPC, with the opportunity to attend meetings and take part in discussions. If you have not participated in BMA work before the scheme is an excellent opportunity to gain experience of what it is like to serve on a committee and contribute to the future of your profession. For further details, please visit the BMA website
LMC observers at GPC meetings
LMC observers are welcome to attend GPC meetings. If your LMC would be interested in sending an observer, please contact Kathryn Reece (kreece@bma.org.uk).
A maximum of three LMC observers may attend any one meeting.
The date for the remaining GPC meetings of the 2019/20 session are below. Meetings will commence at 10:00am and will usually finish at 5:00pm (never later than 6:00pm).
| GPC England | Thursday 16 January 2020 | BMA House, Tavistock Square, London WC1H 9JP |
| GPC UK | Thursday 19 March 2020 | Clayton Hotel Cardiff, St Mary Street Cardiff, Wales |
| GPC England | Thursday 16 July 2020 | BMA House, Tavistock Square, London WC1H 9JP |
Please note that all travel and other expenses for LMC observers should be met by the relevant LMC.
Read the latest GPC newsletter here.
Manifesto commitments
Ahead of the General Election next week on 12 December, the BMA has published a summary of what different party manifestos are pledging on health, available here. The page also includes an analysis of how commitments compare to the BMA’s manifesto ‘asks’ and atemplate to email your prospective parliamentary candidates.
GP trainees’ views on the future of General Practice – King’s Fund report
The King’s Fund produced a report this week based on a survey that received responses from 840 GP trainees in England. This repeated a survey they ran in 2016 and 2018. Key findings included:
It was also worth noting that in the 2016 survey, trainees reported they were considering portfolio working at a later stage in their career, but this year they saw an increase in the number of trainees considering it one and five years after qualifying (24 and 51 per cent, up from 18 and 44 per cent in 2016).
Electronic Prescription Service update (England)
The Electronic Prescription Service (EPS) allows prescribers to send prescriptions electronically to a dispenser of the patient's choice. Phase 4 of the EPS is currently being rolled out on TPP SystmOne. Read more here and see the FAQs attached. The GPC IT policy group lead, Anu Rao, has also written a blog about EPS and the other work streams that the group are involved in.
Currently, dispensing practices are unable to use the EPS for medicines dispensed by the practice dispensary. Further information for dispensing practices has been produced by the DDA and found here. We continue to urge NHS England to enable the implementation of EPS for dispensing practices.
PCN conference 2020 (England)
Building on the success of our first conference for PCN clinical directors earlier this year, we are now preparing for a much bigger event next year. This will provide an opportunity to join other PCN leaders and gain insight into what’s happening across England, share best practice and build supportive relationships. The PCN Conference will be on Saturday 8 February, at the ICC Birmingham. It is suitable for clinical directors, PCN leads and those providing supporting management. Learn more and get your early bird discount at www.bma.org.uk/pcn-whats-next
PCN support services – learning and development for clinical directors (England)
The BMA learning and development team provides a bespoke offer of blended learning, focused on the topics crucial to developing your PCN plan and strategy. Learning will equip clinical directors, and those in supporting roles, with strategic planning, workforce planning, and leadership and management skills to help shape the direction of their PCN. Programmes will run from January to April 2020, in Bristol, Leeds and London. Book nowor find out more on our website.
Scottish LMC conference
Read the resolutions from Scottish LMC conference, held last week, here. These, along with the minutes and agenda, are also available here
Home visits (England)
There have been further reports in the media about the vote at the LMC England conference demanding that home visits should be removed from the core contract. The story was covered by the Independent, New Statesman, and a mention in a Daily Mail article about the King’s Fund poll of GP trainees highlighted above.
Disability survey (UK)
To mark International Day of People with Disabilities on 3 December, the BMA would like to know how disability and ill-health affects the careers of doctors and medical students, and the support you receive or would like to receive at work or in study. Take our short survey here. Earlier this year we spoke to deaf-blind medical student Alexandra Adams – read the feature here
National General Practice Profiles: 2019 annual update (England)
Public Health England has published a data tool presenting a range of GP practice-level indicators using the latest available data in the National General Practice Profiles. This tool is designed to support GPs, CCGs and local authorities to commission effective, appropriate healthcare services for their local populations. Users can search for and view data for individual GP practices and compare them with others in CCGs and across England.
Clinical Academic career progression survey
Are you an academic GP? The BMA’s Medical Academic Staff Committee would very much appreciate if you could fill in their short survey about the changes needed to improve diversity and career progression in medical research, education and clinical academia. Take the survey here
Public Health Conference 2020
Public Health Medicine Committee will be holding their Public Health conference on 26 February 2020 at the BMA House London. The underpinning theme of the conference will be ‘21st century public health’ and what that might mean for public health professionals. The conference will include keynote speakers on the issues of climate change and economic inequality. If you are interested in attending or for further information, please contactinfo.phmc@bma.org.uk
Sandy Macara Memorial Lecture
The Public Health Medicine committee is also organising the ‘Macara Lecture 2020’, to be held at the Wales Millennium Centre on 28 January 2020. This address honours the life and work of the former BMA Council Chair Sir Alexander Macara who died in 2012. The Sandy Macara Memorial Address 2020 is being delivered by Professor Ronan Lyons, Professor of Public Health at Swansea University. The subject of the lecture, ‘Big Data and Public Health’, also picks up on the conference theme of twenty first century public health. If you are interested in this event, please contact info.phmc@bma.org.uk
Read the latest GPC newsletter here.
Scottish LMC conference
I attended the Scottish LMC conference in Glasgow today. Thank you to Teresa Cannavina, chair of conference, and the agenda committee for their welcome. Debates focused on important issues impacting GPs in Scotland, not least the implementation of the first phase of contract changes and consideration of phase 2. The conference also heard from the Cabinet Secretary for Health and Sport, Jeane Freeman MSP, who announced agreement on details of the premises scheme.
You can read the speech given by Andrew Buist, SGPC chair, at the opening of conference, here
LMC England Conference
The webcast from last week’s Conference of England LMCs is now available to view here.
You can also access the conference resolutions and my full speech here.
The conference was reported on by Pulse, BMJ (medicine shortages), Pulse and GP Online (PCNs); BMJ, GP Online and Pulse (fraud in the NHS); BMJ and GP Online (Daphne Romney’s report); GP online and Pulse (hospital contract workload transfer); Chemist and Druggist (drug shortages), Pulse (improved access scheme), and pharmafield (NHSPS service charges)
There was widespread reporting in the national and local media about the vote demanding that home visits should be removed from the core contract, and that a separate service should be commissioned instead. The story was covered by the Daily Mail, Telegraph, Mirror, Sun, Express, Independent, Times, GP Online, Pulse, BMJ, BBC News Online, New Statesman, and I was interviewed by BBC News, BBC News Channel, Sky News and BBC Radio 4. You can listen to my interview with Radio 4 here (from around 14 minutes) and with BBC Radio York here (from 10mins in). GPC England member and deputy chair of the LMC England Conference, Shaba Nabi, also spoke with LBC on the topic.
Northern Ireland LMC Conference 2019 report
The Northern Ireland LMC conference 2019 took place in Belfast on 16 November, with the theme “General Practice in Northern Ireland – are we turning a corner”. Alan Stout, the NI GPC chair, has written a blog about what was discussed and the motions that were passed at the conference. You can also read his conference speech here.
Workforce data (England)
NHS Digital published the workforce data for this quarter, which showed a significant shortfall in GPs as well as doctor vacancies remaining high. According to the statistics, there were 9,319 medical vacancies in England in the second quarter of 2019/20, while there were more than 1,000 fewer full-time equivalent, fully-trained GPs in England than there were in September 2015 when the Government pledged to recruit 5,000 more. In response to this, I said: "The long-term picture is damning, with hundreds fewer full-time equivalent, fully-qualified family doctors than we had this time last year. GP partner numbers are falling at an even faster rate, owing to the additional stresses of owning and running practices. Recent weeks have seen pledges from politicians about increasing GP numbers, but given that we’ve lost 1,000 GPs since we were promised 5,000 more back in 2015, much more needs to be done to make this happen." Read the BMA press release here. This was reported by i Paper, theTelegraph, MailOnline, Pulse, GP Online and LBC radio.
GPs as specialists in General Practice
We have previously agreed a joint statement with the Royal College of GPs and the General Medical Council, which stated that GPs should be considered as expert medical generalists, and as such are specialists in general practice, and that therefore the GP and Specialist Registers should be merged. This week our position has been supported by the Academy of Royal Colleges. Read their statement here.
Performers List to be moved to PCSE online (England)
In December 2019 the management of the performers list will be switched to PCSE online. This will mean that rather than applying for changes to the performers list using paper forms, it will all be processed online. This is intended to provide better transparency of changes to the performer list and provide a more efficient service. Practices will already have received notification to the CQC registered manager to enable approved practice staff to administer practice-based changes to the performer list.
Registration of individuals leaving the secure residential estate (England)
In June 2019, NHS England and NHS Improvement issued information reminding CCGs and GPs of a contractual change in the NHS England Standard General Medical Services (GMS) Contract 2017/18 (see page 64), which means that people can now register with a GP practice prior to their release from the secure residential estate (such as prisons, young offender institutions, immigration removal centres and secure training centres).
The aim of this is to help these individuals maintain continuity of care, avoid unplanned emergency admissions to hospital, and support their rehabilitation. Such individuals can also be initially reluctant to register with their GP practice post-release. Practices should be updating their procedures, as set out here.
NHS England has been advised by healthcare providers working within the secure residential estate, that not all GP practices are aware of this, which has resulted in a number of issues with registering individuals with a community GP practice prior to their release. To help prevent this from happening, and support the registration of these patients, practices are encouraged to familiarise themselves with this process. If you have any queries, please email england.healthandjustice@nhs.net
PCN organisational data service (ODS) codes published (England)
NHS Digital has published organisational data service codes for Primary Care Networks this week, which will provide the PCN name, ODS code, affiliated practices, and ‘lead’ CCG for each PCN. You can access the ODS codes for PCNs here.
Medicine shortages
The MHRA has issued a number of CAS alerts.
Ranitidine - Tablets, effervescent tablets, oral solutions and ranitidine injection are all expected to shortly be out of stock with no date for resupply until further notice. Read more here.
Theophylline (Slo-phyllin) - Manufacture of this product has ceased, and is anticipated to be out of stock by the end of November. Read more here
Emerade adrenaline auto-injector devices (150/300/500 microgram) - will be unavailable for the foreseeable future. Read more here
Read the latest GPC newsletter here.
LMC England Conference
It was good to see many of you at the 2019 Conference of England LMCs which was held today in London. Thanks to Rachel McMahon, chair of conference, and all those who organised this. The webcast will be available next week and we will share it with LMCs as soon as it has been added. You can read my full speech here.
Legal action against NHS Property Services
It was announced today that the BMA is launching legal action against NHS Property Services (NHSPS) over “unjustifiable” rises in service charges faced by GP practices. Practices leasing their buildings from NHSPS have seen their charges rise over the last three years, with no agreement, and sometimes being billed for services they are not receiving. Earlier this year we wrote to NHSPS setting out why we believe they are acting unlawfully, but received no acceptable response. Therefore, the BMA is now taking NHSPS to court.
At the LMC England Conference today, in response to this, I said: “It’s not acceptable that practices in NHS Property Services premises are left to pick up the cost of an unjustifiable hike in charges. As such, we will very shortly be lodging a legal test claim in court which, if successful, would provide a template for GP practices to defend unlawful claims for service charges by NHSPS. We must and we will stand up for GPs and take legal action when it’s necessary to defend our profession.” Read my full statement here. It was reported by the HSJ, Pulse and GP Online, and again in another GP Online piece.
Pensions tax payment for 2019/20
Simon Stevens, chief executive of NHS England and NHS Improvement, has today announced plans for covering the costs of tax on the annual allowance for 2019/20. He has stated that the annual allowance tax charge for this financial year (for anyone that incurs it) will be covered via the scheme pays route and that when the individual retires and claims their pension, the NHS will pay to them the value of the tax charge for 2019/20 (including interest accrued), so covering the cost.
The BMA has responded to this proposal which can be found here. The BMA is continuing to liaise on the details of how this will operate, as well as continuing to lobby for longer-term solutions, including proposals to get rid of the annual allowance altogether.
NHS England’s letter and FAQs are available here
This was reported by Guardian, Pulse, GP Online, Mail Online, HSJ, Personnel Today, This is Money, and Practice Business.
Medicine shortages
A motion demanding urgent action with regard to medicine shortages was passed at the LMC England Conference today. In response to this, Krishna Kasaraneni, GPC England executive team member, said: “Drug shortages can happen for lots of different reasons, but they are undoubtedly getting worse and becoming a daily frustration for both GPs and our patients. GPs often only know about shortages once a patient returns from the pharmacy needing an alternative prescription, which can not only add to our already crippling workload, but also, and most worryingly, delay patients’ treatment. Conference has therefore, acknowledged the benefits of giving pharmacists more control in prescribing safe and considered alternatives, and going forward, there must be systems in place to support pharmacists to ensure they have the necessary patient information to make informed decisions.” This motion was reported on by thePharmaceutical Journal.
The Daily Mail has also reported on shortages on a number of prescription medications, including further comments from Krishna Kasaraneni. Read the full article here.
Amendment of fluoxetine 30mg capsules Serious Shortage Protocol (SSP)
The Department of Health and Social Care has advised that the Serious Shortage Protocol for fluoxetine 30mg capsules (SSP02) is being extended to 18 December 2019. Please also note that this SSP has been changed, so pharmacists now supply fluoxetine 10mg capsules instead of tablets i.e. 1 x 10mg fluoxetine capsule, plus 1 x 20mg fluoxetine capsule. The SSP for fluoxetine 40mg capsules (SSP03) expired yesterday, 21 November, as scheduled.
GPC England meeting
GPC England met yesterday. The GPCE executive and policy leads report, which was received by the committee, is attached.
We received a progress report of the BMA’s Gender Task and Finish Group, and an update from Tom Grinyer, chief executive of the BMA, on the BMA's overall strategy for implementing the important recommendations of the Romney report. The committee also discussed how it could bring the committee specific recommendations of the Romney report into the implementation of the GPC Gender Task and Finish Group which has already been looking at many of the issues which the Romney report addressed.
We were pleased to welcome colleagues from the Pharmaceutical Services Negotiating Committee to give us an update on their recently agreed pharmacy contract. They have produced a PSNC web page outlining how these changes are relevant to GPs, including a briefing document which summarises the changes that would be of particular interest to practices.
The next GPC England meeting will take place on 16 January 2020 and the next GPC UK meeting will take place on Thursday 19 March 2020 in Cardiff, Wales.
General election campaign health pledges – Lib Dems
Following last week’s health pledges from the Conservative Party and Labour Party, the Liberal Democrats published their manifesto this week which include plans to protect the NHS by investing an extra £35 billion in the health service and social care over the next five years. They pledge to end the GP shortfall within five years (2024-25) by both training more GPs and also making better use of nurses, physiotherapists, pharmacists and other health professionals, and also phone or video appointments, where clinically suitable. Of the £35 billion, £32.2 billion would be spent in England, £1.8 billion in Wales and £1 billion in Northern Ireland, with the funding focused on relieving the crisis in social care, tackling urgent workforce shortages, and investing in mental health and prevention services, without any specific reference to general practice. They would also spend £10 billion of capital funding to make the necessary investments in equipment, hospitals, community, ambulance and mental health services buildings, again without any specific information about what would be available for general practice premises.
More doctors needed to fulfil election pledges
The Sunday Times published a letter from me about the GP workforce crisis, where I said: “While election pledges to deliver more family doctors are encouraging, we must not forget that previous promises have fallen far short and GP numbers have continued to decline. We need meaningful action to keep experienced GPs in the NHS, not least the scrapping of absurd pension regulations that punish doctors for staying in work. Both main parties say extra GPs will provide millions more appointments, but thousands more doctors are needed just to meet present demands. Politicians owe it to patients to be realistic about what can be delivered”. Read the letter here (pay wall)
Write to your MP to ensure the next government hears doctors’ voices
Ahead of the General Election on 12 December 2019, you can help ensure the next government hears doctors’ voices by emailing your prospective parliamentary candidates (PPCs) today. The BMA has set up a template to help emailing your PPCs - by filling in your details using our online tool, you can email each of the candidates standing in your constituency.
Social prescriber costs
Following calls from GPC England, LMCs, and PCNs, NHS England has today agreed to extend the purpose of the ARRS (Additional Roles Reimbursement Scheme) funding for Social Prescribers.
We are aware that nearly all organisations supplying a Social Prescriber Link Worker Service (SPLW) are passing on additional cost over and above the equivalent of the actual salary and the on costs, for example in administration fees. The ARRS scheme will be updated so that, where a PCN engages an SPLW service through a supplier, a PCN will be able to claim an additional flat rate sum of £2400 per SPLW (on an annual WTE basis; to be pro-rated by the WTE and duration of the roles providing the service as appropriate) as a contribution toward those additional costs. This must be affordable within the existing maximum annual reimbursable amount for social prescribing link workers.This will apply to any existing supply arrangements for SLPWs and any new supply arrangements for SPLWs agreed from this point forward.
Enhancing shared parental leave (England)
The SPL (shared parental leave) scheme allows parents and adopters more flexibility in how they care for their child during the first year after birth/adoption. Currently the salaried GP contract only allows for enhanced maternity and paternity leave and statutory SPL. Maternity leave and pay in the salaried GP model contract is linked to the provisions of section six of the GWC handbook, rather than the NHS terms and conditions handbook. As such, salaried GPs employed under the model contract are still only entitled to the statutory SPL provisions. The provision for GP contractors will be whatever is set out in their partnership agreements.
GPC England is looking at how enhanced SPL could be provided under the contract. We need to understand the financial impact it will have on practices, if any, in moving from statutory to enhanced SPL, as well as from enhanced maternity/paternity to enhanced SPL. Email info.gpc@bma.org.uk with examples of practices that have introduced enhanced SPL/pay and its impact. All information shared is confidential and will help us make the case for enhancement to NHS England. Read more in a blog by Sarah Westerbeek, of the Sessional GPs committee.
Patient access to records online guidance
GPC England and NHS England have published joint guidance on patient access to records online: prospective record access. This guidance aims to support practices in meeting the commitment to give new registering patients online access to prospective data, subject to existing safeguards for vulnerable groups and third party and system functionality.
GP pressures
Gaurav Gupta, GPC member and premises lead, spoke to BBC's Sunday Politics (South East branch; no recording available) about GP pressures, where he said: "The main strength of the NHS is its people. Unfortunately, in general practice we find GPs are struggling with an unsustainable workload. What we would like from the government is an urgent investment in IT and premises as well as policies to make sure we recruit and retain enough GPs for the population."
Scottish LMC conference
The Scottish LMC conference will be held on Friday 29 November 2019 at the Golden Jubilee Conference Hotel, Clydebank. Read the agenda here
Self care week
It is the annual self care week this week, organised by the Self Care Forum to help people understand the benefits of self care and how they can better look after their own health. Read more in a blog by Dr Andrew Tresidder and on the Patient Liaison Group resources and self-care page
Read the latest GPC newsletter here.
Read about the GP contract changes in Wales here.
General election campaign health pledges
With the general election campaign in progress, parties are starting to publish their plans for general practice should they be elected. Earlier this week the Conservative Party announced that under a Conservative Government they would increase the number of GPs in training by 500 a year from 2021-22 to approximately 4000 a year. They also plan to increase the international recruitment of GPs and to recruit a further 6000 more pharmacists, physios and other GP staff funded by an additional £300 million. In addition, they would intend GP trainees to spend a greater proportion of their training in general practice rather than hospital posts. Read my response to their announcement here. This was reported by Sky News, BBC Online and GP Online. I was interviewed by BBC Radio 4’s Today programme on Saturday – listen here (from 1 hour 37 minutes).
On Wednesday, the Labour Party announced their proposals to expand GP training places to 5000 each year and plan to invest an extra £2.5 billion to overhaul the primary care estate, which follows our joint letter (attached) to the Prime Minister in August, calling for urgent action to ensure funding for primary care premises. They have also committed to providing free prescriptions. Read our response to their announcement here This was reported by the Mirror, Pulse (on the premises pledge).
We support commitments so far made to increase the number of GPs in training as there continues to be an urgent need to address unsustainable workloads and to ensure patients get the care they need. However, creating more training places will only deliver a change if these places can be filled, so more work needs to be done to encourage doctors to choose general practice as a career. There is also much more that needs to be done to retain existing GPs and address the factors that have led to the continued fall in GP numbers resulting in previous promises falling far short.
We are disappointed that both Conservatives and Labour have so far failed to commit to address the current pension issues that punish doctors for staying in work. We await health proposals from the other parties in this election.
NHS crisis: "long term problems must be addressed"
Gaurav Gupta, GPC member and premises policy lead, spoke to BBC Radio Kent on the NHS performance figures and said that the NHS was under ‘incredible pressure’ with BMA analysis showing things will only get worse this winter. He said staff in hospitals and GP practices urgently needed more support in order to cope, however, it was not just about the short-term fix and adding that a ‘long-term sustainable solution’ was essential. He also spoke about the impact of the punitive pension system saying: “We need big tax reform because a lot of senior doctors are being from the system when we need them most.”
Listen to the full interview here (from 53 minutes in).
Flu vaccine delays
PHE have again written to practices in England this week about the delays in nasal influenza vaccine supply which is impacting the school based programme. I was interviewed on ITV Lunchtime news (not available online) on Friday 8 November, about these delays and said: “We need to ensure that everybody gets protected, whether that be children in schools, older patients, or people in care homes, and practices and schools will do their best to make sure that everybody gets protected. But there are concerns that many practices and others have that we are seeing delays in supplies, not just this year, but previous years. We hope that government can work with suppliers to ensure that these delays do not keep happening.”
Self care week
It is the annual self care week next week, 18-24 November. This is a national awareness week organised by the Self Care Forum to help people understand the benefits of self care and how they can better look after their own health. Samira Anane, GPC member GPC member and policy lead for education, training and workforce, has written a blog about how GPs can promoting lifestyle changes for patients – read it here.
There is also GP guidance about patient empowerment as well as guidance on self care for patients, available on the BMA’s Patient Liaison Group resources and self care page.
Northern Ireland LMC Conference 2019
The Northern Ireland LMC conference will take place tomorrow, Saturday 16 November, in Belfast. The theme will be “General Practice in Northern Ireland – are we turning a corner”. You can read more in the blog about the conference by Alan Stout, NI GPC chair. Access the conference agenda here.
LMC England Conference
The Agenda for the forthcoming LMC England Conference to be held on 22 November was published last week. The Conference will be web streamed live via this linkhttps://bma.streameventlive.com/event/115
There was widespread coverage about the debate to be held on home visits, where Kent LMC is calling on the GPC to remove home visits from core contract work for GPs. They argue that GPs no longer have the capacity to provide the service with the LMC saying a separate acute service for urgent visits should be provided by the NHS. This was covered by Mail Online, Telegraph, Independent, Times(paywall), Telegraph, GP Online and Pulse. Pulse also reported on the motion calling the GPC to reject the establishment of PCNs and instead develop a new contract.
LMC England Conference elections
All elections at the LMC England Conference will take place on the BMA’s online election system. Nominations for Chair, Deputy chair, and five members of agenda committee opened today (15 November) at noon and eligible representatives may nominate themselves using the following link
To take part in elections you must have a BMA website account – this can be credited here. You do not need to be a BMA member to create a BMA website account. It is strongly recommended that representatives obtain a BMA website account in advance of conference to ensure there are no complications on the day. The online election system is easily accessible through smartphones, tablets and desktop computers and the BMA provides voting stands at conferences to ensure that all delegates are able to take part in the election process. If you require assistance on the day, please visit the elections team or email elections@bma.org.uk.
Wales LMC Conference 2019
I as pleased to attend the Welsh LMC Conference 2019 which took place last weekend in Llandudno, Wales. Read the speech from Dr Phil White, BMA Cymru Wales GP committee chair here.
Scottish LMC conference
The Scottish LMC conference will be held on Friday 29 November 2019 from 8.30am to 4.45pm at the Golden Jubilee Conference Hotel, Clydebank. Read the agenda here
Position statement on screening
The RCGP has published a Position Statement on Screening by organisations which have not been approved by the UK National Screening Committee, which we fed in to and co-badged.
Women in Academic Medicine survey
The Women in Academic Medicine group, which is part of the BMA’s Medical Academic Staff Committee, has published a short survey to find out the reasoning behind a lack of diversity in academic careers. This is to understand the changes necessary to increase diversity and improve career progression as well as to determine the attractiveness of an academic career. They are particular keen to hear from current and former medical academics, but there are questions for all doctors. Please pass this onto colleagues who may be interested.
BMA launch new website
The beta version of the new BMA website is now live. It will run alongside the current BMA website until it has been developed to the point where it can replace it. Over 500 pages of redesigned content is available. Read more here.
Access the GPC pages here: https://beta.bma.org.uk/what-we-do/committees#general-practitioners-committee The new GPC UK page has more information about the committee, such as the priorities, and also includes links to the GP bulletin, surveys and elections.
BMA support services for GP practices are now here: https://beta.bma.org.uk/advice-and-support/gp-practices#bma-support-services-for-gp-practices
Prescribing costs for 2018-19 published
NHS Digital has published Prescribing Costs in Hospitals and the Community: England 2018-19, which show the estimated costs at list price of medicines used in hospitals and prescribed in primary care. Itincludes the costs at list price, which is the basic cost of a drug excluding VAT. It does not take account of any contract prices or discounts, dispensing costs, fees or prescription charges income.
Medicine supply update
Please see attached the latest medicine supply update from the Department of Health and Social Care medicine supply team.
Read the latest GPC newsletter here.
